Post-Operative Instructions

MEDICATIONS: You will be given a prescription for medication upon discharge from the hospital. Please follow the instructions for administration closely, and call our nursing staff if you experience any problems taking the medication. If you are taking antibiotics, take them until the bottle is completely finished. Refills for medications are to be requested by 3:00 p.m. NO NARCOTIC REFILLS WILL BE GIVEN OVER THE WEEKEND OR AFTER 3:00 P.M. WEEKDAYS. Please leave the following information on your nurse’s voicemail: 1. your name 2. your doctor’s name 3. the medication you are requesting 4. your pharmacy phone number including area code. Remember: Do not take arthritis medications (NSAID’s) or aspirin for at least 3 months after all fusion surgeries. These include Motrin, Aleve, Advil, Naprosyn and Daypro. Females may restart hormones the first week at home.

FOLLOW UP APPOINTMENTS: Unless otherwise indicated by your physician, your first post operative appointment will be approximately 6 weeks following your surgery. Most often, an appointment will be made at the time of discharge from the hospital. If not, please call our office between the hours of 8:00 am – 5:00 pm, Monday through Friday to schedule this appointment.

INCISION CARE: Check your incision at least twice daily for the first 2 weeks for any sign of infection. These signs include increased warmth or redness to the area, swelling, discharge, or unexplained increasing pain in the incision not relieved by bed rest or local application of ice, 5 to 10 minutes, 3 times a day.

DRESSING CHANGES: You may change the dressing the day after you return home (if you have one). A small amount of reddish-brown drainage is not unusual for 1 to 2 days. Please report any other type or amount of drainage to our office. The dressing may be discontinued 24 hours after the incision stops draining or spotting. Showers may begin 2 days after the drainage stops. You may take tub baths 4 weeks after surgery or 2 months after fusion surgery.

If your surgeon used Steri–Strips (adhesive skin closures), they can be removed 14 days following the surgery or whenever they fall off on their own. You may shower as the protocol for your particular surgery permits. Remember to gently dry the incision area / Steri-Strips. It is common for the edges of the strips to loosen and curl. Simply clip the frayed edges but try to leave the strips on for 14 days unless they are so loose they are obviously no longer functional. In this case, you may gently lift off the strips, but do not pull or jerk to remove them. Do not apply cream / ointments to the incision.

PAIN EXPECTATIONS: After lumbar fusion you may have occasional low back pain for 3 – 6 months with gradual resolution. After cervical surgery, you will have predictable muscle pain for up to 6 weeks post operatively. A sore throat often occurs after intubation for anesthesia. After all surgeries, inflammation is a natural process of healing. We cannot and do not want to block this process. Please know we can take the “edge” off your pain, but we cannot stop ALL your pain. With each day that passes, you will get stronger and oftentimes, must simply be patient as nature clicks off days on the calendar. You need to be encouraged by the “good days” as the “bad days” get further apart.

REMEMBER: Call our office immediately if you:

1. Have drainage and / or odor from your wound.
2. Have increased redness / swelling at the incision site, or unexplained increasing incisional pain not relieved by bed rest.
3. Have fever greater than 101 degrees with sweats or chills.
4. Have new or unfamiliar pain or weakness in the arms or legs.
5. Have difficulty with urination or bowel movements, pain or numbness in the rectal, vaginal or scrotal area.

GENERAL INFORMATION DURING YOUR FIRST 6 WEEKS AFTER SURGERY

• Activity, especially walking around your home is encouraged. Try to do so at least 6 times daily.
• Activity should be in increments; for the first few weeks you should have at least six 15-20 minute rest periods during the day. Daytime naps are discouraged. The rest periods are not intended for sleep.
• Do not do heavy housework, such as bed making, vacuuming or laundry.
• If using stairs is necessary, go slowly and use the handrail.
• Do not twist, bend, or lift anything over 10 lbs. If you return to a sedentary job, you must abide by these restrictions. A letter can be faxed from our office stating these restrictions.
• No special exercises are necessary. Continue the abdominal and leg isometrics you were doing in the hospital.
  A physical therapist may be ordered for one to two visits once you are home from the hospital only to check the safety of your environment/living quarters. The therapist is not authorized to add additional exercises.
• An increased intake of water, 6 to 8 glasses per day, will help clear your body of anesthetics and excess pain medication, and will increase the ease of bowel movements.
• With the use of narcotic medications, simple constipation is common. Increasing your intake of fiber with a daily supplement such as Metamucil is often helpful. Avoid extended use of stimulant laxatives.
• Avoid sitting in chairs and on sofas that are low to the ground and avoid sleeping on a mattress with the height not equal to that of your mid thigh. This will make transfer in and out of bed easier.
• For discectomy patients, try not to sit longer than 15 – 30 minutes during a 2 hour period. Shorten those periods if soreness develops. This soreness is generally muscular in origin, and can often be helped with alternating local application of heat or ice.
• If you have had a lumbar fusion, wait until after the first post-operative office visit (6 weeks) before having any sexual activity. Otherwise, you may resume normal activity after two weeks.
• Do not drive until after we have seen you at your first post-operative visit, unless otherwise approved by your physician. Riding in the car is okay unless otherwise directed.
• Spine fusion patients cannot smoke for 6 months after surgery. You must also avoid nicotine products (smokeless tobacco, gum, patches) and avoid exposure to smoke from other smokers.
• REMEMBER, spine fusion patients are to avoid the use of NSAID’s (arthritis medication) for at least 3 months after surgery. Consult your physician prior to resuming these medications.
• Braces or corsets are to be worn at all times when out of bed, unless showering. At your first post-operative visit, you will be given further instructions. If you have a halo, halo pins must be cleaned twice daily with one-half (1/2) strength Hydrogen Peroxide and water using cotton swabs.
• If your surgery includes the use of spinal implants (rods, plates, screws, etc.) be sure to inform any physician planning other surgery for you in the first 6 months. This includes any dental surgery or deep dental cleaning. We suggest that your physician or dentist use the American Heart Association guidelines for antibiotic prophylaxis.
• A physician is always on call to assist with any emergency after hours, holidays or weekends. Please call 404-778-5000.